Communities and healthcare professionals are calling for a variety of public school anti-obesity initiatives, which need to be approached with caution. With no reliable or accepted clinical measure of obesity in growing children, many children are being inappropriately labeled and stigmatized as fat. The vast majority of children do not have weight problems. While intuitive, these programs are not evidence-based and none to date has proven effective in reducing long-term obesity. But they are resulting in unprecedented levels of body hatred, unhealthy and inappropriate weight loss attempts, fears of food, increased susceptibility to media messages, eating disorders, nutritional deficits, and weight discrimination. This article reviews the evidence surrounding childhood obesity and the health paradigm which has been shown to give lasting positive outcomes for children's health and well-being.
Get full access to this article
View all access options for this article.
References
1.
FlegalK. M., Defining Obesity in Children and Adolescents: Epidemiologic Approaches, Critical Review of Food Science and Nutrition, 33: 4, pp. 307–312, 1993.
2.
LaneK. A. G. (ed.), Chapter 256: Health Management in Normal Newborns, Infants, and Children, in The Merck Manual of Diagnosis and Therapy, 17th Edition, Merck & Co., Inc., Whitehouse Station, New Jersey, 2004. Available online at: http://www.merck.com/mrkshared/mmanual/section19/chapter256/256d.jsp
3.
PowerC., Measurement and Long-term Health Risks of Child and Adolescent Fatness, International Journal of Obesity, 21: 7, pp. 507–526, 1997.
4.
Federal Update: BMI Poor Indicator of Body Fat in Individual Kids, Journal of the American Dietetic Association, 100: 628, 2000.
5.
PietrobelliA.FaithM. S.AllisonD. B.GallagherD.ChiumelloG., and HeymsfieldS. B., BMI as a Measure of Adiposity among Children and Adolescents: A Validation Study, Journal of Pediatrics, 132: 2, pp. 204–210, 1998.
SatterE. M., Internal Regulation and the Evolution of Normal Growth as the Basis for Prevention of Obesity in Children, Journal of the American Dietetic Association, 96, pp. 860–864.
8.
WidhalmK. and SchoneggerK., BMI: Does It Really Reflect Body Fat Mass?Journal of Pediatrics, 134: 4, p. 522, 1999.
9.
KuczmarksR. and RocheA. (chairmen), NCHS Growth Chart Workshop Report; Division of Health Examination Statistics. Washington: U.S. Health and Human Services, Centers for Disease Control, National Center for Health Statistics, pp. 1–88, December 12–15, 1992.
10.
StimsonK., Deconstructing Media Misinformation, www.largesse.net/Deconstruct, Largesse Network for Size Esteem, 2000.
11.
MeiZuguo Z.Grummer-StrawnL. M.ThompsonD., and DietzW. H., Shifts in Percentiles of Growth During Early Childhood: Analysis of Longitudinal Data from the California Child Health Development Study, Pediatrics, 113: 6, pp. e617–e627, 2004.
12.
SatterE., Secrets of Feeding a Healthy Family, Kelcy Press, Madison, Wisconsin, pp. 3–209, 1999.
Pennsylvania Health Department Study Shows 18-percent of 8th Graders Overweight, Pennsylvania Department of Health Press Release, February 4, 2004.
15.
O'DeaJ., Prevention of Child Obesity: First, Do No Harm, Health Education Research, 24, pp. 7–14, 2004.
16.
ThompsonT. G.GeberdingJ. L. L., and SondikE. J., Health United States 2002, Washington, DC: U.S. Health and Human Services, Centers for Disease Control, National Center for Health Statistics, August 2002. Available online at: http://www.cdc.gov/nchs/data/hus/hus02.pdf
17.
DietzW. H., Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease, Pediatrics, 101: 3 Supplement, pp. 518–525, 1998.
18.
WrightC. M.ParkerL.LamontD.CraftA. W., and SpenceJ., Implications of Childhood Obesity for Adult Health: Findings from Thousand Families Cohort Study, British Medical Journal, 323, pp. 1280–1284, 2001.
SerdulaM. K.IveryD.CoatesR. J.FreedmanD. S.WilliamsonD. F., and ByersT., Do Obese Children Become Obese Adults? A Review of the Literature, Preventive Medicine, 22, pp. 167–177, 1993.
21.
American Academy of Pediatrics, Policy Statement of Soft Drinks in Schools Committee on School Health, Pediatrics, 113: 1, pp. 152–154, 2004.
22.
LudwigD. S.PetersonK. E., and GortmakerS. L., Relation Between Consumption of Sugar-Sweetened Drinks and Childhood Obesity: A Prospective, Observational Analysis, Lancet, 357, pp. 505–508, 2001.
23.
BrownellK., Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It, McGraw-Hill Co., New York, p. 169, 2004.
KlurfeldD., Pediatric Obesity, American Council on Science and Health Letters, September 16, 2003. www.acsh.com (May 15, 2004).
26.
NestleM., Soft Drink ‘Pouring Rights’: Marketing Empty Calories to Children, Public Health Report, 115, pp. 308–319, 2000.
27.
HarnackL.StangJ., and StoreyM., Soft Drink Consumption among U.S. Children and Adolescents: Nutritional Consequences, Journal of the American Dietetic Association, 99: 4, pp. 435–441, 1999.
28.
ParkY. K.MeierE. R.BianchiP., and SongW. O., Trends in Children's Consumption of Beverages: 1987 to 1998, Family Economics and Nutrition Review, 14: 2, pp. 69–79, 2002.
29.
BandiniL. G.SchoellerD. A., and DietzW. H., Energy Expenditure in Obese and Non-Obese Adolescents, Pediatric Research, 27, pp. 198–203, 1990.
30.
BradyL. M.LindquistC. H.HerdS. L., and GoranM. I., Comparison of Children's Dietary Intake Patterns with U.S. Dietary Guidelines, British Journal of Nutrition, 84, pp. 361–367, 2000.
31.
KantA. K., Reported Consumption of Low-Nutrient-Density Foods by American Children and Adolescents Nutritional and Health Correlates, NHANES III, 1988 to 1994, Archives of Pediatric Adolescent Medicine, 157, pp. 789–796, 2003.
32.
ForsheeR. and StoreyM., Total Beverage Consumption and Beverage Choices Among Children and Adolescents, International Journal of Food Science and Nutrition, 54: 4, pp. 297–307, 2003.
33.
FieldA. E.AustinS. B.GillmanM. W.RosnerB.RockettH. R., and ColditzG. A., Snack Food Intake Does Not Predict Weight Change among Children and Adolescents, International Journal of Obesity, 28: 10, pp. 1210–1216, 2004.
34.
StoreyM. L.ForsheeR. A.WeaverA. R., and SansaloneW. R., Demographic and Lifestyle Factors Associated with Body Mass Index among Children and Adolescents, International Journal of Food Science Nutrition, 54: 2, pp. 491–503, 2003.
35.
ClydesdaleF. M., Nutrition and Health Aspects of Sugars, American Journal of Clinical Nutrition, 62, pp. 161S–296S, 1995.
36.
ForsheeR. and StoreyM., The Role of Added Sugars in the Diet Quality of Children and Adolescents, Journal of the American College of Nutrition, 20: 1, pp. 32–43, 2001.
37.
MardisA., Current Knowledge of the Health Effects of Sugar, Family Economy and Nutrition Review, 13: 1, p. 87, 2001.
38.
Sugars Task Force, Evaluation of Health Aspects of Sugars Contained in Carbohydrate Sweeteners, U.S. Dept. of Health and Human Services, Food and Drug Administration, Washington, D.C., 1986.
39.
GlinsmannW. H.IransquinH., and ParkY. K., Report from FDA's Sugars Task Force: Evaluation of Health Aspects of Sugars Contained in Carbohydrate Sweeteners, Journal of Nutrition, 166: 155, pp. 51–216, 1986.
40.
National Research Council, Committee on Diet and Health, Food and Nutrition Board, Diet and Health: Implications for Reducing Chronic Disease Risk, National Academy Press, Washington, D.C., 1989.
41.
U.S. Dept. of Agriculture and U.S. Dept. of Health and Human Services, Nutrition and Your Health: Dietary Guidelines for Americans, 3rd Ed., HNIS Home and Garden Bulletin, 232, pp. 1–27, 1990.
42.
Public Health Service, U.S. Dept. of Health and Human Services, The Surgeon General's Report on Nutrition and Health, DHHS(PHS) Publication No. 88-50210, U.S. Government Printing Office, Washington, D.C., 1988.
American Dietetic Association, Position Paper: Total Diet Approach to Communicating food and Nutrition Information, Journal of the American Dietetic Association, 102, p. 100, 2002.
45.
Food and Nutrition Board, Institute of Medicine, Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients), Appendix J: Association of Added Sugar Intake, National Academy Press, Washington, D.C., pp. 893–902, 2002.
46.
International Food Information Council, Review: Sweet Facts About Sugars and Health, IFIC, Washington, D.C., August 1995.
American Academy of Pediatrics Committee on Nutrition, The Use of Fruit Juice in the Diet of Young Children, American Academy of Pediatrics Policy Statement, February 1991. www.aap.com
49.
DennisonB. A.RockwellH. L., and BakerS. L., Excess Fruit Juice Consumption by Preschool-Aged Children is Associated with Short Stature and Obesity, Pediatrics, 99, pp. 15–22, 1997.
50.
HuffmanG. B., Impact of Excess Juice Intake on Growth in Young Children, American Family Physician, 55, p. 8, 1997.
51.
HoldenJ., USDA National Nutrient Database for Standard Reference, Release 16–1, Agricultural Research Service, March 5, 2004.
52.
EbbelingC. B.PawlakD. B., and LudwigD. S., Childhood Obesity: Public-Health Crisis, Common Sense Cure, Lancet, 360, pp. 473–482, 2002.
53.
ResnicowK., School-based Obesity Prevention: Population versus High-Risk Intervention, Annals of the New York Academy of Science, 699, pp. 154–166, 1993.
54.
StoreyM., School-based Approaches for Preventing and Treating Obesity, International Journal of Obesity Related Metabolic Disorders, 23, S43–S51, 1999.
55.
RitchieL.IveyS.MaschM.Woodward-LopezG.IkedaJ., and CrawfordP., Pediatric Overweight: A Review of the Literature, University of California-Berkeley, Center of Weight and Health, College of Natural Resources, Berkeley, California, pp. 1–127, June 2001.
56.
DonnellyJ. E.JacobsenD. J.WhatleyJ. C.HillJ. O.SwiftL. L.CherringtonA.PolkB.TranL. V., and ReedG., Nutrition and Physical Activity and Metabolic Fitness in Elementary School Children, Obesity Research, 4, pp. 229–243, 1996.
57.
GiddingS. S.LeibelR. L.DanielsS.RosenbaumM.Van HornL., and MarxG. R., American Heart Association Medical Scientific Statement: Understanding Obesity in Youth, Circulation, 94, pp. 3383–3387, 1996.
58.
AtkinsonR. L. and NitzkeS. A., School Based Programmes On Obesity, British Medical Journal, 323, pp. 1018–1019, 2001.
59.
StoreyM., Statement Before U.S. Department of Agriculture Dietary Guidelines Advisory Committee, transcripts 47–49, March 8, 1999.
60.
FriedmanJ., Modern Science versus the Stigma of Obesity, Nature Medicine, 10: 6, pp. 563–569, 2004.
61.
AlexyU.Sichert-HellertW.KerstingM., and Schultze-PawlitschkoV., Pattern of Long-Term Fat Intake and BMI During Childhood and Adolescence—Results of the DONALD Study, International Journal of Obesity, 28, pp. 1203–1209, 2004.
62.
KaterK. J., An Effective Model for Preventing and Reversing Body Image, Eating and Weight Problems, Balance Journal of the Mental Health Association, 2004.
63.
PerseghinG.PriceT. B.PetersenK. F.RodenM.ClineG. W.GerowK.RothmanD. L., and ShulmanG. I., Increased Glucose Transport-Phosphorylation and Muscle Glycogen Synthesis after Exercise Training in Insulin-Resistant Subjects, New England Journal of Medicine, 335: 18, pp. 1357–1362, 1996.
64.
WattsK.BeyeP.SiafarikasA.DavisE. A.JonesT. W.O'DriscollG., and GreenD. J., Exercise Training Normalizes Vascular Dysfunction and Improves Central Adiposity in Obese Adolescents, Journal of the American College of Cardiology, 43(10), pp. 1823–1827, 2004.
65.
KingN. and HayesD., Shame, Blame, and the ‘War on Childhood Obesity’: Confronting the Real Problems, Identifying the Positive Solutions, Healthy Weight Journal, 17: 2, p. 28, 2003.
66.
FaithM. S.LeoneM. A.AyersT. S.HeoM., and PietrobelliA., Weight Criticism During Physical Activity, Coping Skills, and Reported Physical Activity in Children, Pediatrics, 110: 2, p. e23, 2002.
67.
CramerP. and SteinwertT., Thin is Good, Fat is Bad: How Early Does It Begin?, Journal of Applied Developmental Psychology, 19, pp. 429–451, 1998.
68.
CoughlinJ. W., Body Image Dissatisfaction in Children: Prevalence and Parental Influence, Health Weight Journal, 17: 4, p. 56, 2003.
69.
DavisonK. K.MarkeyC. N., and BirchL. L., Etiology of Body Dissatisfaction and Weight Concerns among 5-Year-Old Girls, Appetite, 35, pp. 143–151, 2000.
70.
SticeE.HaywardC.CameronR. P.KillenJ. D., and TaylorC. B., Body-Image and Eating Disturbances Predict Onset of Depression among Female Adolescents: A Longitudinal Study, Journal of Abnormal Psychology, 109, pp, 438–444, 2000.
71.
KellyC.RicciardelliL. A., and ClarkeJ. D., Problem Eating Attitudes and Behaviors in Young Children, International Journal of Eating Disorders, 25, pp. 281–286, 1999.
72.
RicciardelliL. A. and McCabeM. P., Children's Body Image Concerns and Eating Disturbance—Review of the Literature, Clinical Psychology Review, 21, pp. 325–345, 2001.
73.
RobisonJ., The ‘Obesity Epidemic’: An Alternative Perspective, Healthy Weight Journal, 17: 1, p. 1, 2003.
74.
O'DeaJ., The New Self-Esteem Approach for the Prevention of Body Image and Eating Problems in Children and Adolescents, Healthy Weight Journal, 16: 6, p. 90, 2000.
75.
Striegel-MooreR. H. and Kearney-CookeA., Exploring Parents' Attitudes and Behaviors about Their Children's Physical Appearance, International Journal of Eating Disorders, 15, pp. 377–385, 1994.
76.
SticeE.CameronR. P.KillenJ. D.HaywardC., and TaylorC. B., Naturalistic Weight Reduction Efforts Prospectively Predict Growth in Relative Weight and Onset of Obesity Among Female Adolescents, Journal of Consulting Clinical Psychology, 67, pp. 967–974, 1999.
77.
BergF., Women Afraid to Eat—Breaking Free in Today's Weight-Obsessed World, Healthy Weight Network, Hettinger, North Dakota, pp. 15–380, 2000.
78.
DavisJ. L., Teen Girls Turning to Body-Shaping Diet Pills, www.webmd.com, June 17, 2004.
KidsHealth® KidsPoll—Obesity Poll: Summary of Findings, Southern Illinois University, 2004. Available online at: http://nahec.org/KidsPoll
81.
DeAngelisT., Size-Based Discrimination May be Hardest on Children, American Psychological Association Monitor on Psychology, 35: 1, p. 62, 2004.
82.
BirchL. L. and FisherJ. A., Appetite and Eating Behavior in Children, Pediatric Clinical Nutrition America, 42, pp. 931–953, 1995.
83.
Centers for Disease Control and Prevention, Energy and Macronutrient Intakes of Persons Ages 2 Months and Over in the U.S., 1988–1991, MMWR Morbidity & Mortality Weekly Report, 43, pp. 116–125, 1994.
84.
BirchL. L. and DeysherM., Caloric Compensation and Sensory Specific Satiety: Evidence for Self-Regulation of Food Intake by Young Children, Appetite, 7, pp. 323–331, 1986.
85.
BirchL. L.JohnsonS. L.AndresenG.PetersJ. C., and SchulteM. C., The Variability of Young Children's Energy Intake, New England Journal of Medicine, 324, pp. 232–235, 1991.
86.
DruckerR. R.HammerL. D.AgrasW. S., and BrysonS., Can Mothers Influence Their Child's Eating Behavior?Journal of Developmental Behavior Pediatrics, 20, pp. 88–92, 1999.
87.
FisherJ. O. and BirchL. L., Restricting Access to Foods and Children's Eating, Appetite, 32, pp. 405–419, 1999.
88.
CrawfordP. B. and ShapiroL. R., How Obesity Develops: A New Look at Nature and Nurture, Obesity and Health, 40, p. 1, 1991.
89.
FisherJ. O. and BirchL. L., Restricting Access to Palatable Foods Affects Children's Behavior Response, Food Selection and Intake, American Journal of Clinical Nutrition, 69, pp. 1264–1272, 1999.
O'DeaJ. and AbrahamS., Improving the Body Image, Eating Attitudes, and Behaviors of Young Male and Female Adolescents: A New Educational Approach that Focuses on Self-Esteem, International Journal of Eating Disorders, 28, pp. 43–57, 2000.
92.
KaterK.RohwerJ., and LondreK., Evaluation of An Upper Elementary School Program to Prevent Body Image, Eating and Weight Concerns, Journal of School Health, 72: 5, pp. 199–204, 2002.
FuenkesG. I.de GraafC.MeyboomS., and van StaverenW. A., Food Choice and Fat Intake of Adolescents and Adults: Associations of Intakes Within Social Networks, Preventive Medicine, 27, pp. 645–656, 1998.
95.
SatterE., How to Get Your Kids to Eat … But Not Too Much, Bull Publishing, Boulder, Colorado, 1987.
96.
RobisonJ., Bringing the ‘War on Obesity’ to Our Children, Healthy Weight Journal, 17: 2, p. 17, 2003.
